Broken tracheostomy tube flanges in the tracheo-bronchial region

A young adult tracheostomy dependent male, 25 years of age having quadriplegia due to cerebrovascular accident, following a renal transplantation, was brought to emergency room of E.N.T. Department, Civil Hospital Karachi with dyspnoea and cough. His postero-anterior and ablique skiagram of the chest showed fractured flanges of metallic tracheostomy tube in the lower trachea and right main bronchus. Both the broken flanges of outer tube were removed under local spray of 4% Xylocaine through tracheostome with Stortz's rigid bronchoscope. Pathogenesis of the damages to the metallic tracheostomy tube is discussed